Wells’ Syndrome Associated With Idiopathic Hypereosinophilic Syndrome in a Child: A Case Report

Wells' syndrome is a rare inflammatory disease characterized by recurrent, erythematous plaques with histological flame figures, which can be associated with idiopathic hypereosinophilic syndrome (IHES). We present a case of a nine-year-old boy who presented with a one-year history of an itchy rash on his legs associated with peripheral eosinophilia. The rash initially started as an annular plaque and developed raised borders with central hyperpigmentation. A skin biopsy revealed histopathological features consistent with Wells' syndrome, including flame figures and eosinophilic infiltrate. Other investigations revealed hypereosinophilia and bone marrow eosinophilia. Our case demonstrates Wells' syndrome associated with IHES in a child. This overlap renders both diagnosis and treatment challenges. Corticosteroids are effective for Wells' syndrome but may require augmentation with additional therapies for IHES, such as dupilumab. The diagnosis of Wells' syndrome with IHES in this patient underlines the necessity for clinicians to consider and rule out other eosinophilic disorders. It highlights the value of a multidisciplinary strategy to enhance management and optimize outcomes. This case provides valuable insight into the comprehension of rare eosinophilic disorders, but additional research is required in this field to better understand the underlying pathophysiologic mechanisms of these disorders.